CLINICAL NURSING JUDGMENT 1

Clinical Nursing Judgment

Lisa Palmer

March 19, 2018

Youngstown State University

Clinical nursing judgement is the foundation of what it means to be a nurse. It is defined

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as the process by which the nurse decides on data to be collected about a client, makes an

interpretation of the data, arrives at a nursing diagnosis, and identifies appropriate nursing

actions. Nursing clinical judgment involves critical thinking, problem solving, and decision

making (Medical Dictionary, p. 1). Nursing judgement is such an important factor when it

involves caring for a patient. It is necessary in order to properly care for a patient. It plays an

important role in identifying nursing actions that need to be taken. Without good clinical nursing

judgment it is nearly impossible to be a competent registered nurse. It is the basis of all nursing

practice and forms the foundation of care being given to the patient.

Many nursing research studies have identified concepts and processes that explore the

reasoning behind clinical judgment in registered nurses. In a study conducted by Maggi Banning,

she looked at how exactly nursing judgment is made in a general situation. During clinical

reasoning, there is an interaction among the individual’s cognition, the subject matter, and the

context of the situation where the thinking occurs. Nurses use multiple cognitive processes such

as making judgements on the use of evidence based on past experience but also on underpinning

knowledge, judging client situations, hypotheses generation, diagnostic reasoning and reflection

(Banning, p. 3). Nurses have a variety of different skill sets that allow them to recognize a

situation that would require clinical nursing judgement. For example, the article touches on the

differences in thinking in experienced nurses compared to student nurses or new nurses. When

faced with a problem experienced nurses revert to past experiences to guide them into making

the best judgement to ahem the best outcome for their patients. When new or student nurses are

faced with a problem they do not have past experiences to revert to so, they rely on what they

have learned. At the heart of good clinical judgment and clinical wisdom lies experiential

learning from particular cases. Bad judgments must be refined and corrected in particular cases;
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anomalies and distinctions must be noticed (Benner p. 4). When a nurse is put in a situation that

nursing judgment needs to be made, it is important to determine after the fact if correct

judgement was made or if improvements are needed. Its very important to identify aspects that

need improvement so that if mistakes are made, the nurse does not make the same mistakes

again. Both experienced and new nurses would look at the context of the situation and judge the

client’s conditions. For example, if the pulse oximeter is reading low the nurse is able to first

look at and assess the client to see if its an accurate reading or if the probe isn't picking up

correctly. This aspect of clinical nursing judgment is a huge part of nursing as a whole. It is

probably one of the most important parts. Nurses need to know to always assess the patient to

judge whether or not some kind of intervention is needed.

In a separate study, nurses took a questionnaire to evaluate their own personal nursing

judgment and also how to improve it. One interesting suggestion was using a method similar to

doctors. “Providing care to patients based on Orem’s model helped us make autonomy

independently from physicians”. Another nurse added, “One of our patients was experiencing

urinary retention. We, based on clinical practice guidelines, could judge whether the patient

needed suprapubic bladder massage or any other intervention” (Seidi, p.3). Using an approach

like this would give nurses a step by step approach in patient care. This approach would

definitely help new nurses guide them in nursing interventions. A major problem with this would

be each patient is different and all patients would not fit into a mold. Each individual patient has

their own needs to be met and need to have their own individual care plan. This approach would

be very useful in emergency situations when nurses need to know the next step, although it could

be time consuming. Having a tool like this available to nurses would greatly benefit them. Any

resources made available to nurses could help in their overall clinical nursing judgment.
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Standard measurements of vital signs and laboratory metrics are examples of clinical

assessments that can be reduced to techne. But note that skillfulness and craft based on

experience may still be essential to successful performance of techne. In situations where the

patient’s particular response must be considered, and perceptual acuity is required to recognize

salient changes in the patient, as well as situations where attuned relationships and judgment

require skillful comportment, both techne and phronesis (situated actions based on skill,

judgment, character, and wisdom) are essential (Brenner, p. 6). Clinical nursing judgment is all

about assessing a patient and determining if an action by the nurse is required. Vital signs are a

very important factor in a patient’s health but, it is important to identify normal trends in a

specific patient. For example, blood pressure. Some patients run a low pressure, its important for

the nurse to identify the trend and assess if the patient is in distress or if the pressure is their

normal baseline. Identifying these trends help the nurse form better clinical nursing judgement.

One specific time I remember using clinical nursing judgment was in professional three

on a telemetry floor. My patient was eating, then felt tired, so she laid down. She reported feeling

like she was having trouble breathing. So I used my judgment in identifying she was

experiencing dyspnea and the first thing I did was put the head of the ed up. Next, I put her

oxygen on and looked at her pulse oximeter. Her saturation improved from being in the 80’s to

being in the middle 90’s. Using good clinical judgment helped my patient from progressing into

a more serious respiratory distress.

To conclude, clinical nursing judgement is a very important factor in caring for patients.

Nursing judgment has many aspects to it that help shape a nurse into making good judgements.

This includes, experiences, critical thinking, problem solving, and decision making. It is

necessary in order for a nurse to make care plans and coordinate according to a specific patient.
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Good nursing judgment is improved with experience and through learning experiences. Clinical

nursing judgment is the basis of all nursing practice and forms the foundation of the care that is

given to the patient.

Citations

Banning, M. (2006, March). Measures that can be used to instill critical thinking skills in nurse

prescribers. Retrieved March 16, 2018, from http://www.nurseeducationinpractice.com/

Benner, P., Tanner, C., & Chesla, C. (n.d.). Expertise in Nursing Practice. Retrieved March 16,

2018.

Seidi, J., & Ahlani, F. (n.d.). Nurses’ Clinical Judgment Development:. Retrieved March 16,

2018.